Treatment by Over-the-Scope-Clip

The Over-The-Scope-Clip (OTSC Proctology) is part of the novel armamentarium for the treatment for complicated and complex anorectal fistulas, which is based on high-technology devices. OTSC Proctology consists of an elastic Nitinol clip and of a stapler-like clip applicator. If the clip is transanally applied on the internal fistula opening, and the clip closes and seals the orifice, leading to the healing of the fistula. In the hands of experienced rectal surgeons, OTSC Proctology is an intuitive surgical instrument which allows a sphincter-preserving minimally invasive fistula operation. The patient’s subjective burden and postoperative pain after clip surgery is relatively low leading to a short hospitalization and recovery time. The experiences gained with clip procedure in many international centers so far demonstrates that it is feasible, safe, and effective and renders reproducible data. The clip shows favorable results especially in cryptoglandular fistulas and when OTSC is used as a first-line treatment. OTSC Proctology has proven not only to be a “salvage technique” or “plan B” after the failure of other fistula procedures. The technique can repeatedly be used without causing major tissue damage or hamper other surgical interventions. There is reason to believe that the combination of the clip with other modern surgical techniques with a different principle of fistula healing, such as VAAFT or FiLaC, may have a beneficial synergistic effect.